BILATERAL SIMULTANEOUS RHEGMATOGENOUS RETINAL DETACHMENT: Clinical Characteristics and Surgical Outcome

Two Cases of Bilateral Rhegmatogenous Retinal Detachment During Orthokeratology Treatment

Orthokeratology may be effective in slowing myopic progression. However, whether orthokeratology is beneficial enough to prevent rhegmatogenous retinal detachment formation remains unclear. Two cases of bilateral rhegmatogenous retinal detachment were seen during orthokeratology treatment and corrected with scleral buckling and cryopexy under general anesthesia. This is the first report of bilateral retinal detachment found during orthokeratology treatment. Although orthokeratology is effective for myopic correction and prevents axial length elongation, patients still have a risk of rhegmatogenous retinal detachment. Careful follow-up not only of the anterior segment but also of the peripheral retina is necessary.

Bilateral sequential and simultaneous rhegmatogenous retinal detachments: anatomic and functional outcomes

OBJECTIVE

To assess the anatomic and functional outcomes in sequential and simultaneous bilateral rhegmatogenous retinal detachment (BRRD) repair.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 218 eyes in 109 patients.

METHODS

Patients diagnosed with BRRD between 2014 and 2020 at the University Centre of Ophthalmology-CHU de Québec-Laval University were reviewed. Main outcomes were single-surgery anatomic success (SSAS) and final pinhole visual acuity (PHVA) in logMARs.

RESULTS

Of the 109 patients, 86 (79%) were male, and median (Q1, Q3) age at presentation for the first eye was 60 years (range, 54-66 years). Of these patients, 92% (n = 100) had sequential BRRD and 8% (n = 9) simultaneous BRRD. Median (Q1, Q3) duration of symptoms was shorter for second eyes (first, 7 days [range, 3-15 days] vs second, 4 days [range, 2-10 days]; p = 0.028). Second eyes also had less retinal tears (first, 2.94 ± 2.76 tears vs second, 2.38 ± 1.79 tears; p = 0.031) and better median preoperative PHVA (first, 0.46 logMAR [range, 0.14-2.30 logMAR] vs second, 0.24 logMAR [range, 0.06-0.95 logMAR]; p = 0.012). SSAS was achieved in 100 (92%) and 101 (93%) of first and second eyes, respectively (p = 1.00). Final PHVA was better for the first eye (first, 0.14 logMAR [range, 0.04-0.30 logMAR] vs second, 0.20 logMAR [range, 0.04-0.43 logMAR]; p = 0.010) but comparable at 3 months (first, 0.30 logMAR [range, 0.14-0.48 logMAR] vs second, 0.34 logMAR [range, 0.13-0.70 logMAR]; p = 0.36).

CONCLUSIONS

SSAS was similar for both eyes. The subsequent eye was more likely to be treated earlier with less advanced presentations, but at 3 months, PHVA was not significantly different between eyes. Difference in final PHVA may be attributable to longer follow-up in first eyes.

Characteristics of Bilateral Retinal Detachment

INTRODUCTION

Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is analysing the specific characteristics of bilateral rhegmatogenous RD.

METHODS

The files of all 5,791 consecutive eyes undergoing vitreoretinal surgery for uncomplicated RD in a single tertiary retinal centre between January 2005 and June 2021 were retrospectively reviewed.

RESULTS

A total of 300 patients (600 eyes) had bilateral retinal detachment. Interval between initial and subsequent RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years. Symptoms were reported by the patients for 20 ± 75 (median 5) days before presentation in the initial eye and 12 ± 32 (median 4) days in the subsequent eye. 220 patients were male (73%), and mean age at initial RD was 55 years. 183 (61%) of the initial RD eyes were phakic. In the initial eye, more patients had a detached macula, worse visual acuity, and more quadrants involved. Primary anatomic success rate was higher in the subsequent eye (90%) compared to the initial eye (83%). There was no difference in the reattachment rate of fellow eyes with primary failure in the first eye (91%) compared to those with primary success in the first eye (90%). There was a high symmetry between the eyes in terms of type of retinal break, number of breaks, and presumed localization of the causative retinal break.

CONCLUSION

Patients with bilateral RD were more commonly male and younger than the group of all RD patients. The proportion of pseudophakia was not different. The majority of fellow eye RD occurred within 2 years after the RD in the first eye. Second eye RD was less advanced and had a better anatomical repair rate. Despite their experience in the first eye and despite typical symptoms, patients presented only after a mean of 12 days with RD in the second eye. RD in the initial and the subsequent eye showed a high symmetry. The anatomic result in the first eye is not a predictor for the anatomic result in the subsequent eye.

Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis

PURPOSE

To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison.

DESIGN

Multicenter, retrospective cohort study.

PARTICIPANTS

Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included.

METHODS

Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison.

MAIN OUTCOME MEASURES

Single-operation anatomic success between the initial-eye and subsequent-eye RRD.

RESULTS

Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010).

CONCLUSIONS

In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.

Immediate Sequential Bilateral Vitreoretinal Surgery: Descriptive Case Series and Literature Review

BACKGROUND AND OBJECTIVE

Bilateral vision-threatening disease necessitating urgent surgery in both eyes is challenging in vitreoretinal disorders, where surgeries are often longer and higher risk than in other ocular disorders. The authors present a case series of patients undergoing immediate sequential bilateral vitreoretinal surgery (ISBVS) on the same day.

PATIENTS AND METHODS

Retrospective case series and literature review. Main outcome measures were surgical indications, systemic diseases, presenting and final visual acuity, and adverse events or complications during or after surgery.

RESULTS

During the time period searched, 14 patients underwent ISBVS, without significant adverse events, infections, or complications. Illustrative cases are presented.

CONCLUSION

The authors recommend considering ISBVS under certain conditions, such as in patients who are unable to undergo local anesthesia surgery, and in those who definitely require urgent or semi-urgent bilateral vitreoretinal surgery requiring a second general anesthesia in the near future if performed separately, especially in cases where the anesthesia is considered high risk. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:494-498.].